The Five Core Competencies of Drug Treatment

Contributed By: Robert Pfeifer, MSW, Founder of Sober College

forestAugust 2015 marked the four year anniversary of the American Society of Addiction Medicine’s (ASAM) monumental change in redefining addiction from a behavioral/character disorder to a brain based disease.

This definition change is well entrenched into the drug and alcohol treatment community, however the methodologies and approaches to treatment are more slowly being realized and integrated.


Sobriety is an interruption of the negative behaviors and the move towards a healthier lifestyle. Abstinence from chemical substances give the brain a much needed rest and provides it with the opportunity to heal. This is critical to the very early recovery process.

While a 12-step approach is not the only way to achieve sobriety, it is probably the most broadly accepted. From a brain perspective, the abstinence and involvement in the 12-step community contributes to overall brain health and a fuller integration of both right and left hemispheres.

Addiction is a left hemisphere brain experience where short term solutions and control strategies are the order of the day. Compare this to a recovery meeting which allows uninterrupted storytelling and invites movement into the right hemisphere as a person learns to connect with something greater than themselves.

Additionally the naming of an addictive experience can engage the prefrontal cortex and calm the amygdala which is fully aroused in active addiction.


hand of woman meditating in a yoga pose on beach at sunsetFitness should be a critical component of any drug treatment program.

Physical fitness plays many important roles regarding mental health, but also has important and critical processes that help stabilize the central nervous system, positively impacting dopamine and serotonin levels.

Increased blood flow from fitness related activities keeps the blood pumping and can aid in cleaning out a person’s system much more quickly.

Life Skills

Life skills training is very often needed in recovering drug and alcohol addicts who have spent their lives struggling to make good and positive choices. Skills like time management, conflict resolution and planning are foreign to many clients and most need assistance in managing the daily tasks of life that cause them stress and ultimately lead to relapse.

Life skills training has brain benefits as well. Cravings control incorporates the ability to listen and take direction from others despite the impulses of the brain. The internal brain cravings can be so strong that a person must reach out externally to get the support they need to make better decisions.

This is a skill that can be taught and learned and involves taking direction from others (“time to wake up” or “time to do chores”) and following through on their suggestions.


Productivity is operating with a sense of purpose through activities that are vocational or academic in nature. This is a domain that is sometimes missed in traditional early treatment, yet has tremendous social and brain benefits.

Young man in the officeThe act of studying plays a critical role in building Long Term Potentiation which is the development of new synapses in the brain.

Additionally, we know that there is a huge amount of deficiency in Executive Functioning among addicted clients and skills like attention, problem solving, cognitive issues and working memory have been impacted.

In addition to the self-esteem that one gets from participation in the higher education process, involvement in academics provides critical executive functioning skills.

Emotional Intelligence

Last but not least, Emotional Intelligence is a proactive clinical and therapeutic modality that incorporates critical elements of Neuropsychological Somatic Mindfulness. Emotional intelligence takes the client through experiential therapeutic activities that are designed to be resiliency through critical relapse prevention skills. Also included are:

  • Group
  • Individual psychotherapy
  • Ppsychiatry
  • Mindfulness training
  • Emotional regulation
  • Rapid Trauma Resolution (to diffuse negative impacts of trauma and grief)
  • Anti-craving medications (when indicated to shore up client resiliency)

The father with the son on bicycles,with a retro effectThe process of drug treatment takes on many shapes, sizes and forms as more and more providers come into the field.

Comprehensive approaches are critical to the success of a program and having a fully integrated team is critical to effective program quality.

The Five Competencies of Sobriety, Fitness, Life Skills, Productivity and Emotional Intelligence help to define a successful drug and alcohol treatment program and all of these elements should be available to someone when they are seeking help for themselves or a loved one.

Community Discussion – Share your thoughts here!

How has your recovery been impacted by the five competencies? What advice do you have to share?

Robert PfeiferAbout Sober College: As Sober College nears its ten year anniversary and starts to branch out to satellite locations like San Diego, we are beginning to understand the relevance of our Five Core Competency treatment model to all levels of care, including residential, intensive outpatient, outpatient and supportive aftercare. Excelling in these five domains is not only great for our clients, it should be present and required for participants in any drug treatment program. In the case of Sober College, we provide our clients the opportunity to attend classes in the earliest parts of the treatment process. The difference is that the courses are offered on-site, away from the dangerous triggers that exist on a college campus.

The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Addiction Hope understand that addictions result from a combination of environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on November 6, 2015
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About Baxter Ekern

Baxter Ekern is the Vice President of Ekern Enterprises, Inc. He contributed and helped write a major portion of Addiction Hope and is responsible for the operations of the website.